Ariz. Admin. Code § R9-25-802 - Minimum Standards for an Air Ambulance (Authorized by A.R.S. Sections 36-2202(A)(3), (4), and (5); 36-2209(A)(2); and 36-2212)

A. An applicant or certificate holder shall ensure that an air ambulance has:

1. A climate control system to prevent temperature extremes that would adversely affect patient care;

2. If a fixed-wing air ambulance, pressurization capability;

3. Interior lighting that allows for patient care and monitoring without interfering with the pilot's vision;

4. For each place where a patient may be positioned, at least one electrical power outlet or other power source that is capable of operating all electrically powered medical equipment without compromising the operation of any electrical aircraft equipment;

5. A back-up source of electrical power or batteries capable of operating all electrically powered life-support equipment for at least one hour;

6. An entry that allows for patient loading and unloading without rotating a patient and stretcher more than 30 degrees about the longitudinal axis or 45 degrees about the lateral axis and without compromising the operation of monitoring systems, intravenous lines, or manual or mechanical ventilation;

7. A configuration that allows each medical team member sufficient access to each patient to begin and maintain treatment modalities, including complete access to the patient's head and upper body for effective airway management;

8. A configuration that allows for rapid exit of personnel and patients, without obstruction from stretchers and medical equipment;

9. A configuration that protects the aircraft's flight controls, throttles, and communications equipment from any intentional or accidental interference from a patient or equipment and supplies;

10. A padded interior or an interior that is clear of objects or projections in the head strike envelope;

11. An installed self-activating emergency locator transmitter;

12. A voice communications system that:

a. Is capable of air-to-ground communication, and

b. Allows the flight crew and medical team members to communicate with each other during flight;

13. Interior patient compartment wall and floor coverings that are:

a. Free of cuts or tears,

b. Made from non-absorbent material,

b.c. Capable of being disinfected, and

c.d. Maintained in a sanitary manner; and

14. If a rotor-wing air ambulance, the following:

a. A searchlight that:

i. Has a range of motion of at least 90 degrees vertically and 180 degrees horizontally,

ii. Is capable of illuminating a landing site, and

iii. Is located so that the pilot can operate the searchlight without removing the pilot's hands from the aircraft's flight controls;

b. Restraining devices that can be used to prevent a patient from interfering with the pilot or the aircraft's flight controls; and

c. A light to illuminate the tail rotor.

B. An applicant or certificate holder shall ensure that:

1. Except as provided in subsections (D), (E), and (F), each air ambulance has the equipment and supplies required in subsection (C) for each mission for which the air ambulance is used; and

2. The equipment and supplies on an air ambulance are secured, stored, and maintained in a manner that prevents hazards to personnel and patients.

C. An applicant or certificate holder shall ensure that an air ambulance used for an advanced life support mission or critical care mission has the following equipment and supplies:

1. The following ventilation and airway equipment and supplies:

a. Portable and fixed suction apparatus, with wide-bore tubing, rigid pharyngeal curved suction tip, tonsillar and flexible suction catheters, 5F-14F;

b. Portable and fixed oxygen equipment, with variable flow regulators;

c. Oxygen administration equipment, including: tubing; non-rebreathing masks (adult and pediatric sizes); and nasal cannulas (adult and pediatric sizes);

d. Bag-valve mask, with hand-operated, self-reexpanding bag (adult size), with oxygen reservoir/accumulator; mask (adult, pediatric, infant, and neonate sizes); and valve;

e. Airways, oropharyngeal (adult, pediatric, and infant sizes);

f. Laryngoscope handle, adult and pediatric, with, if applicable, extra batteries and bulbs;

g. Laryngoscope blades, sizes 0, 1, and 2, straight; sizes 3 and 4, straight and curved;

h. Endotracheal tube cuff pressure manometer;

i. Endotracheal tubes, sizes 2.5-5.0 mm cuffed or uncuffed and 6.0-8.0 mm cuffed;

j. Stylettes for Endotracheal tubes, adult and pediatric;

k. Airways, nasal (adult, pediatric, and infant sizes), one each in French sizes 16 to 34;

l. One type of supraglottic airway device, adult and pediatric;

m. 10 mL straight-tip syringes;

n. Small volume nebulizer or nebulizers and aerosol masks, adult and pediatric;

o. Magill forceps, adult and pediatric;

p. Nasogastric tubes, sizes 5F and 8F, Salem sump sizes 14F and 18F;

q. End-tidal CO2 detectors, quantitative;

r. Portable automatic ventilator with positive end expiratory pressure; and

s. In-line viral/bacterial filter;

2. The following monitoring and defibrillation equipment and supplies:

a. Portable, battery-operated monitor/defibrillator, with:

i. Tape write-out/recorder,

ii. Defibrillator pads,

iii. Adult and pediatric paddles or hands-free patches,

iv. ECG leads,

v. Adult and pediatric chest attachment electrodes, and

vi. Capability to provide electrical discharge below 25 watt-seconds; and

b. Transcutaneous cardiac pacemaker, either stand-alone unit or integrated into monitor/defibrillator;

3. For rotor wing aircraft only, the following immobilization devices and supplies:

a. Cervical collars, rigid, adjustable or in an assortment of adult and pediatric sizes;

b. Head immobilization device, either firm padding or another commercial device;

c. Lower extremity (femur) traction device, including lower extremity, limb support slings, padded ankle hitch, padded pelvic support, and traction strap; and

d. Upper and lower extremity immobilization splints;

4. The following bandages:

a. Burn pack, including standard package, clean burn sheets;

b. Dressings, including:

i. Sterile multi-trauma dressings (various large and small sizes);

ii. Abdominal pads, 10" x 12" or larger; and

iii. 4" x 4" gauze sponges;

c. Gauze rolls, sterile (4" or larger);

d. Elastic bandages, non-sterile (4" or larger);

e. Occlusive dressing, sterile, 3" x 8" or larger; and

f. Adhesive or self-adhesive tape, including various sizes (1" or larger) hypoallergenic and various sizes (1" or larger) adhesive or self-adhesive;

5. The following obstetrical equipment and supplies:

a. Separate sterile obstetrical kit, including:

i. Towels,

ii. 4" x 4" dressing,

iii. Umbilical tape,

iv. Sterile scissors or other cutting utensil,

v. Bulb suction,

vi. Clamps for cord,

vii. Sterile gloves,

viii. Blankets, and

ix. A head cover; and

b. An alternate portable patient heat source or two heat packs;

6. The following infection control equipment and supplies, including the availability of latex-free:

a. Eye protection (full peripheral glasses or goggles, face shield);

b. Masks, at least as protective as a National Institute for Occupational Safety and Health-approved N-95 respirator, which are fit-tested;

c. Gloves, non-sterile;

d. Jumpsuits or gowns;

e. Shoe covers;

f. Disinfectant hand wash, commercial antimicrobial (towelette, spray, or liquid);

g. Disinfectant solution for cleaning equipment;

h. Standard sharps containers;

i. Disposable red trash bags; and

j. Protective facemasks or cloth face coverings for patients;

7. The following injury prevention equipment:

a. Appropriate restraints, such as seat belts or, if applicable, child safety restraints, for patient, personnel, and family members;

b. For rotor wing aircraft only, safety vest or other garment with reflective material for each personnel member;

c. Fire extinguisher, either disposable with an indicator of a full charge or with a current inspection tag;

d. Hazardous material reference guide; and

e. Hearing protection for patient and personnel;

8. The following vascular access equipment and supplies:

a. Intravenous administration equipment, with fluid in bags;

b. Antiseptic solution (alcohol wipes and povidone-iodine wipes);

c. Intravenous pole or roof hook;

d. Intravenous catheters 14G-24G;

e. Intraosseous needles, adult and pediatric sizes;

f. Venous tourniquet;

g. One of each of the following types of intravenous solution administration sets:

i. A set with blood tubing,

ii. A set capable of delivering 60 drops per cc, and

iii. A set capable of delivering 10 or 15 drops per cc;

h. Intravenous arm boards, adult and pediatric;

i. IV pump or pumps (minimum of 3 infusion lines); and

j. IV pressure bag;

9. The agents, specified in a table of agents established according to A.R.S. §§ 36-2204 and available through the Department at www.azdhs.gov/ems-regulatory-references, that an administrative medical director has authorized for use, based on the EMCT classification of the medical team; and

10. The following miscellaneous equipment and supplies:

a. Sphygmomanometer (infant, pediatric, and adult regular and large sizes);

b. Stethoscope;

c. Pediatric equipment sizing reference guide;

d. Thermometer with low temperature capability;

e. Heavy bandage or paramedic scissors for cutting clothing, belts, and boots;

f. Cold packs;

g. Flashlight (1) with extra batteries or recharger, as applicable;

h. Blankets;

i. Sheets;

j. Disposable emesis bags or basins;

k. For fixed wing aircraft only, a disposable bedpan;

l. For fixed wing aircraft only, a disposable urinal;

m. Properly secured patient transport system;

n. Lubricating jelly (water soluble);

o. Glucometer or blood glucose measuring device with reagent strips;

p. Pulse oximeter with pediatric and adult probes;

q. Automatic blood pressure monitor; and

r. A commercially available trauma arterial tourniquet.

D. An applicant or certificate holder shall ensure that an air ambulance used for an interfacility maternal transport mission has:

1. The equipment and supplies in subsection (C); and

2. The following:

a. A Doppler fetal heart monitor;

b. Unless use is not indicated for the patient as determined through on-line medical direction or on-line medical guidance provided as described in R9-25-708(A)(3), an external fetal heart and tocographic monitor with printer capability;

c. Tocolytic and anti-hypertensive medications;

d. Advanced emergency cardiac life support equipment and supplies; and

e. Neonatal resuscitation equipment and supplies.

E. An applicant or certificate holder shall ensure that an air ambulance used for an interfacility neonatal transport mission has:

1. The equipment and supplies in subsection (C); and

2. The following:

a. A transport incubator with:

i. Battery and inverter capabilities,

ii. An infant safety restraint system, and

iii. An integrated neonatal-capable pressure ventilator with oxygen-air supply and blender;

b. An invasive automatic blood pressure monitor;

c. A neonatal monitor or monitors with heart rate, respiratory rate, temperature, non-invasive blood pressure, and pulse oximetry capabilities;

d. Neonatal-specific drug concentrations and doses;

e. Thoracostomy supplies;

f. Neonatal resuscitation equipment and supplies;

g. A neonatal size cuff (size 2, 3, or 4) for use with an automatic blood pressure monitor; and

h. A neonatal probe for use with a pulse oximeter.

C.F. A certificate holder may conduct a critical care interfacility transport mission using an air ambulance that does not have all of the equipment and supplies required in subsection (C) if:

1. Care of the patient to be transported necessitates use of life-support equipment that, because of its size or weight or both, makes it unsafe or impossible for the air ambulance to carry all of the equipment and supplies required in subsection (C), as determined by the certificate holder based upon:

a. The individual aircraft's capabilities,

b. The size and weight of the equipment and supplies required in subsection (C) and of the additional life-support equipment,

c. The composition of the required medical team, and

d. Environmental factors such as density altitude;

2. The certificate holder ensures that, during the mission, the air ambulance has the equipment and supplies necessary to provide an appropriate level of medical care for the patient and to protect the health and safety of the personnel on the mission; and

3. The certificate holder ensures that, during the mission, the air ambulance is not directed by the air ambulance service or another person to conduct another mission before returning to a base location;

4.3. The certificate holder ensures that the air ambulance is not used for another mission until the air ambulance has all of the equipment and supplies required in subsection (C).

5. Within five working days after each interfacility critical care mission conducted as permitted under subsection (C), the certificate holder creates a record that includes the information required under R9-25-710(A)(8), a description of the life-support equipment used on the mission, a list of the equipment and supplies required in Table 1 that were removed from the air ambulance for the mission, and the justification for conducting the mission as permitted under subsection (C).

Notes

Ariz. Admin. Code § R9-25-802

R9-25-802 recodified from A.A.C. R9-13-1502 (Supp. 98-1). Section repealed; new Section made by exempt rulemaking at 7 A.A.R. 4092, effective September 1, 2001 (Supp. 01-3). Amended by exempt rulemaking at 8 A.A.R. 931, effective February 15, 2002 (Supp. 02-1). Amended by exempt rulemaking at 10 A.A.R. 239, effective January 3, 2004 (Supp. 03-4). Section recodified to R9-25-502 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1). Renumbered from R9-25-807 and amended by final rulemaking at 28 A.A.R. 842, effective 6/5/2022.